CRFP-0511-BMS2700000001-3 | MEDICAID MANAGED CARE RATE SETTING/PROGRAM ADMIN

The State of West Virginia, through the Bureau for Medical Services, is soliciting proposals under CRFP-0511-BMS2700000001-3 for Medicaid managed care rate setting, program administration, and actuarial services. The contract encompasses a wide range of professional services, including lead and staff actuary services, managed care oversight, financial services, and technical and clerical support. The procurement utilizes a CLIN-style pricing structure consisting of hourly rates and fixed annual amounts, with provisions for a base year and optional renewal periods for up to five years. The solicitation is governed by strict submission guidelines, prohibiting online responses and requiring adherence to federal procurement standards under 2 C.F.R. for contracts involving federal funds. In addition to the primary administrative and actuarial services, the procurement framework includes a Pilot Pharmacy Cost Containment Program for Medicaid and the Children's Health Insurance Program, which utilizes a Per Member Per Month operational cost model and specific implementation fees. The contract is supported by comprehensive compliance requirements, including a HIPAA Business Associate Addendum for the handling of protected health information and detailed Service Level Agreements that impose financial penalties for delayed deliverables. Managed Care Organizations are also subject to rigorous reporting requirements across quarterly, quality, provider, and financial categories to ensure program oversight and federal compliance.